Provider Demographics
NPI:1093949067
Name:ROSTESCU, BRENDA ESTRADA (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ESTRADA
Last Name:ROSTESCU
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:E
Other - Last Name:ROSTESCU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTAL
Mailing Address - Street 1:3944 N OKETO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2124
Mailing Address - Country:US
Mailing Address - Phone:773-625-5412
Mailing Address - Fax:
Practice Address - Street 1:3944 N OKETO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2124
Practice Address - Country:US
Practice Address - Phone:773-625-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.002325224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant